Chronic recurrent multifocal osteomyelitis

Classification according to ICD-10
M86.3	Chronic multifocal osteomyelitis
ICD-10 online (WHO version 2019)

The chronic recurrent multifocal osteomyelitis ( CRMO ) is a chronic non-bacterial osteomyelitis , ie an inflammatory disease of the bone ( osteomyelitis ) without detectable pathogens.

The main localization is the metaphyses of the long tubular bones , the spine , the pelvis and the shoulder girdle .

It was first described in 1972 by the Swiss pediatric radiologist Andres Giedion and colleagues.

distribution

The frequency is given as 4 in 1,000,000 children. The disease occurs in childhood with first manifestations around the age of 10, in adults a similar disease is called SAPHO syndrome .

root cause

The aetiology and the pathomechanism are not exactly known, but there is a direct relationship to enthesitis-associated arthritis and psoriatic arthritis. No mutations were found. It is not yet clear whether it is an autoimmune disease.

Clinical manifestations

Clinical criteria are:

chronic recurrent pain
local swelling
Restriction of movement

diagnosis

The diagnosis results from the combination of clinical, radiological and, if necessary, histological findings. It is a diagnosis of exclusion .

X-rays and laboratory tests are inefficient, the previously used skeletal scintigraphy has already been replaced by magnetic resonance imaging because of the radiation exposure (in children and adolescents) .

Magnetic resonance tomography in the whole-body process (GK-MRT) is used as the imaging method of choice today .

Differential diagnosis

First and foremost, they must be delimited

acute and chronic bacterial osteomyelitis
juvenile idiopathic arthritis
Hypophosphatasia
Langerhans cell histiocytosis
malignant diseases such as osteosarcoma , Ewing's sarcoma and other
The associated with skin lesions very rare autosomal - recessive inherited Majeed syndrome .
Pachydermoperiostosis
Cranio-Osteoarthropathy

therapy

The treatment is carried out with non-steroidal anti-inflammatory drugs ( NSAID ), alternatively with bisphosphonates and TNF blockers . The sintering of vertebral bodies with the formation of a vertebra plana , which occurs not infrequently, sometimes requires special treatment.

course

Characteristic is the course with spontaneous remission or improvement and sudden occurrence of new changes. Associations with autoimmune diseases, especially chronic inflammatory bowel diseases, have been described.

literature

F. Schilling, S. Kessler: Chronic recurrent multifocal osteomyelitis (CRMO) part 1. Overview. In: Clinical Pediatrics. Vol. 213, No. 5, 2001 Sep-Oct, pp. 271-276, doi : 10.1055 / s-2001-17218 , PMID 11582525 (review).
F. Schilling, A. Eckardt, S. Kessler: The chronic recurrent multifocal osteomyelitis. In: Journal for orthopedics and their border areas. Vol. 138, No. 6, 2000 Nov-Dec, pp. 530-539, doi : 10.1055 / s-2000-9597 , PMID 11199420 (review).
J. Ferrari, C. Pilkington: Chronic recurrent multifocal osteomyelitis: the prevalence of lower-limb and foot involvement. In: Journal of the American Podiatric Medical Association. Vol. 104, No. 6, November 2014, pp. 583-587, doi : 10.7547 / 8750-7315-104.6.583 , PMID 25514269 .

Individual evidence

↑ HJ Girschick, P. Raab, S. Surbaum, A. Trusen, S. Kirschner, P. Schneider, T. Papadopoulos, HK Müller-Hermelink, PE Lipsky: Chronic non-bacterial osteomyelitis in children. In: Annals of the rheumatic diseases. Vol. 64, No. 2, February 2005, pp. 279-285, doi : 10.1136 / ard.2004.023838 , PMID 15647436 , PMC 1755336 (free full text).
↑ Chronic recurrent multifocal osteomyelitis. In: Online Mendelian Inheritance in Man . (English)
↑ ^a ^b ^c ^d ^e ^f ^g Chronic recurrent multifocal osteomyelitis. In: Orphanet (Rare Disease Database).
↑ ^a ^b ^c ^d ^e ^f N. Wagner, G. Dannecker (editor): Pediatric Rheumatology. S. 524 ff., Springer 2007, ISBN 978-3-540-32814-8 .
↑ A. Giedion, W. Holthusen, LF Masel, D. Vischer: [Subacute and chronic "symmetrical" osteomyelitis]. In: Annales de radiologie. Vol. 15, No. 3, 1972 Mar-Apr, pp. 329-342, PMID 4403064 .
^ AF Jansson, V. Grote: Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. In: Acta paediatrica (Oslo, Norway: 1992). Vol. 100, No. 8, August 2011, pp. 1150-1157, doi : 10.1111 / j.1651-2227.2011.02205.x , PMID 21352353 .
↑ T. von Kalle, N. Heim, T. Hospach, M. Langendörfer, P. Winkler, T. Stuber: Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). In: RöFo : Advances in the field of X-rays and nuclear medicine. Vol. 185, No. 7, July 2013, pp. 655-661, doi : 10.1055 / s-0033-1335283 , PMID 23696017 .
↑ AM Korchi, S. Hanquinet, M. Anooshiravani, L. Merlini: Whole-body magnetic resonance imaging: an essential tool for diagnosis and work up of non-oncological systemic diseases in children. In: Minerva pediatrica. Vol. 66, No. 3, June 2014, pp. 169-176, PMID 24826973 .
↑ T. Hospach, M. Langendoerfer, T. von Kalle, J. Maier, GE Dannecker: Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. In: European Journal of Pediatrics. Vol. 169, No. 9, September 2010, pp. 1105-1111, doi : 10.1007 / s00431-010-1188-5 , PMID 20339868 .
↑ GK Audu, K. Nikaki, D. Crespi, C. Spray, J. Epstein: Chronic recurrent multifocal osteomyelitis and inflammatory bowel disease. In: Journal of Pediatric Gastroenterology and Nutrition . Vol. 60, No. 5, May 2015, pp. 586-591, doi : 10.1097 / MPG.0000000000000663 , PMID 25493348 .

[1] HJ Girschick, P. Raab, S. Surbaum, A. Trusen, S. Kirschner, P. Schneider, T. Papadopoulos, HK Müller-Hermelink, PE Lipsky: Chronic non-bacterial osteomyelitis in children. In: Annals of the rheumatic diseases. Vol. 64, No. 2, February 2005, pp. 279-285, doi : 10.1136 / ard.2004.023838 , PMID 15647436 , PMC 1755336 (free full text).

[OMIM-2] Chronic recurrent multifocal osteomyelitis. In: Online Mendelian Inheritance in Man . (English)

[Orpha-3] ↑ ^a ^b ^c ^d ^e ^f ^g Chronic recurrent multifocal osteomyelitis. In: Orphanet (Rare Disease Database).

[Wagner-4] ↑ ^a ^b ^c ^d ^e ^f N. Wagner, G. Dannecker (editor): Pediatric Rheumatology. S. 524 ff., Springer 2007, ISBN 978-3-540-32814-8 .

[5] A. Giedion, W. Holthusen, LF Masel, D. Vischer: [Subacute and chronic "symmetrical" osteomyelitis]. In: Annales de radiologie. Vol. 15, No. 3, 1972 Mar-Apr, pp. 329-342, PMID 4403064 .

[6] AF Jansson, V. Grote: Nonbacterial osteitis in children: data of a German Incidence Surveillance Study. In: Acta paediatrica (Oslo, Norway: 1992). Vol. 100, No. 8, August 2011, pp. 1150-1157, doi : 10.1111 / j.1651-2227.2011.02205.x , PMID 21352353 .

[Kalle-7] T. von Kalle, N. Heim, T. Hospach, M. Langendörfer, P. Winkler, T. Stuber: Typical patterns of bone involvement in whole-body MRI of patients with chronic recurrent multifocal osteomyelitis (CRMO). In: RöFo : Advances in the field of X-rays and nuclear medicine. Vol. 185, No. 7, July 2013, pp. 655-661, doi : 10.1055 / s-0033-1335283 , PMID 23696017 .

[8] AM Korchi, S. Hanquinet, M. Anooshiravani, L. Merlini: Whole-body magnetic resonance imaging: an essential tool for diagnosis and work up of non-oncological systemic diseases in children. In: Minerva pediatrica. Vol. 66, No. 3, June 2014, pp. 169-176, PMID 24826973 .

[9] T. Hospach, M. Langendoerfer, T. von Kalle, J. Maier, GE Dannecker: Spinal involvement in chronic recurrent multifocal osteomyelitis (CRMO) in childhood and effect of pamidronate. In: European Journal of Pediatrics. Vol. 169, No. 9, September 2010, pp. 1105-1111, doi : 10.1007 / s00431-010-1188-5 , PMID 20339868 .

[10] GK Audu, K. Nikaki, D. Crespi, C. Spray, J. Epstein: Chronic recurrent multifocal osteomyelitis and inflammatory bowel disease. In: Journal of Pediatric Gastroenterology and Nutrition . Vol. 60, No. 5, May 2015, pp. 586-591, doi : 10.1097 / MPG.0000000000000663 , PMID 25493348 .